GSCCC Membership 2020

Thank you for renewing your membership in the Gulf States Camera Club Council. Please fill out the form below and submit your annual dues via PayPal. You do not have to have a PayPal account to continue.
Club Name*
Meeting Location*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Term Starts

MonthDayYear
Date
Term Ends

MonthDayYear
Date
President Name*

First NameLast Name
President Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
President Email*
example@example.com
President Phone*

Area CodePhone Number
Treasurer Name*

First NameLast Name
Treasurer Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Treasurer Email*
example@example.com
Treasurer Phone *

Area CodePhone Number
Newsletter Editor Name

First NameLast Name
Newsletter Editor Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Newsletter Editor Email
example@example.com
Newsletter Editor Phone

Area CodePhone Number
GSCCC Rep Name*

First NameLast Name
GSCCC Rep Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
GSCCC Rep Email*
example@example.com
GSCCC Rep Phone*

Area CodePhone Number
If you have separate persons in charge of GSCCC Competition entries, please list below.
Competition Category
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number

Area CodePhone Number
Competition Category
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number

Area CodePhone Number
Competition Category
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number

Area CodePhone Number
Competition Category
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number

Area CodePhone Number
Competition Category
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number

Area CodePhone Number
Is your club a member of PSA?*

YesNo
What competitions does your club participate in?

Pictorial Color PrintsPictorial B&W PrintsPictorial ProjectedPJ PrintsPJ ProjectedNature PrintsNature ProjectedNone
Membership Type*
prevnext( X )
1-25 Members$20.00

26 or more Members$30.00

Pay Pal Fee$3.00

Total $0.00
Enter the message as it's shown*
When you submit this form you will be directed to PayPal for payment. If you have a PayPal account, log in and continue. If you do not have an account you may choose the pay with credit card option which is located below the log in information. If you have concerns, please email gulfstatesccc@gmail.com and we will be happy to assist you.
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